"Service not received due to catchment area dispute"

District Nurses refuse to attend cancer patient because of territorial dispute. This is shockingly bad.

Less than two weeks ago my husband had it confirmed that his skin cancer had returned and it had travelled to his lymph nodes. He was now stage 3 Melanoma. Within 8 days he was admitted for surgery to have lymph nodes removed from his armpit. The surgery went well and he recovered well on Otter Ward. Two days after surgery the consultant informed us that he was fit to be discharged into community care with a drain in situ which had to stay in place for at least five days and be monitored until output was low enough to be removed.

My husband and I had only recently moved house. We are now approx 400 yards outside our registered GP’s surgery in the Westbank catchment boundary line but my husband was reassured that the continuity of his care would be maintained by his GP if he registered for ‘out of area care’. This was very important to my husband who wished for continuity of care whilst experiencing what life is like with a cancer diagnosis. 

We now understand that moving from Westbank to the local Dawlish practise also moves us between Exeter and Torbay Health authorities.

When the nurses on the ward where discussing discharging him home it was explained to them several times about the necessity to check that the District Nurses would visit us as there could be an issue with the provision of the care as events had overtaken any necessary paperwork. My husband was registered with one practise but the District Nurse care may need to come from another. 

My husband received his discharge form annotated with the comment “the community nurses have kindly agreed to provide care”. He therefore left hospital, with his drip and six empty bottles, on the clear understanding that his nursing care had been arranged and would continue.

Oh no....it did not! 

The very next day, less than 24 hours after being discharged, his drip started leaking. It was completely full as it had not been changed once since his surgery or prior to his discharge. (Despite his querying if it needed to be changed before his discharge!)

Frantic phone calls were then made to our GP surgery to ascertain when the District Nurses would be arriving. It transpired that the District Nurses linked to our registered practice, were refusing to do a home visit as we were outside the practise area (by 400 yards in a rural area!). Alarm bells rang and panic began to set in as the realisation dawned that despite every effort on our part to ensure there was going to be continuity of care - and it had been confirmed in writing to us - it was not going to materialise. 

Otter Ward was phoned and after many attempts we finally got through. We then learnt that the ward can only make a request for a home visit.....it was not guaranteed. By this stage my husband’s night shirt, pillowcases and bedding are all drenched with leaking fluid. 

So with no other option available we had to ask for instructions how to do it ourselves. 

Yes, we were expected to do our own nursing care for a leaking drain wound. 

With the nurse on the phone explaining about pressures and sensations my husband may experience we managed to change the bottle. Then we got asked had we any dressings.....no.....the ward did not give us any.....that’s what the District Nurses bring. Dismay set in again. 

Afterwards the ward nurse explained that our registered practice district nurses were still refusing to do a home visit and my husband would have to register at a new practice now.......and then Dawlish district nurses would visit him. This was so disheartening for my husband. We both were crestfallen that, in essence, we were being blackmailed into changing our GP surgery and our right to register (or on our case remain) with a preferred practise was being ignored. Not by the GP practise but the District Nurse administration.

I went to Starcross surgery and asked for a meeting with the practice manager. One of the GP’s there, who knew both my husband and I, sat in on the meeting. They listened patiently and sympathetically with the awful situation my husband was experiencing. I showed them the discharge letter and they explained that the ward nurses fax/email the requests to the District Nurses but they don’t speak to them, and they don’t wait for a reply. We were not told that on discharge. I also learnt that the District Nurses are part of the RD&E and are not contracted/employed by the surgery. We were not told that on discharge. The GP’s have no authority over them whatsoever. They kindly assisted me in completing a temporary registration form for my husband and faxed it to Dawlish to break the impasse.

Two hours later my husband finally gets a telephone call to say that the district nurses will be with him shortly. They arrived at 4pm......six hours after his drain had started leaking and four hours after we had to take care of the problem on a DIY basis. A sure indication that getting a form signed was non negotiable.

This has to be one of the worst experiences of my life where administration boundaries have become more important than putting compassionate nursing care in place. Paperwork can wait. A leaking wound will not!

Hospital Nurses.....you should be ashamed of yourselves to put a patient who is only just out of surgery through such a stressful ordeal by not ensuring community nursing care had been set up and the potential difficulties highlighted to you had been properly addressed. 

District Nurses......you should be ashamed that administration and territory seems to be prioritised ahead of patient care. 

The managers and administrators who appear to blindly follow the rules on boundary lines drawn on a map in a rural area without the slightest hint of practicality......hang your heads in shame. 

Once in attendance the District Nurse Care has been excellent.

My husband’s GP phoned my husband to personally apologise. 

My GP’s practise manager phoned my husband to personally apologise. 

It seems to me like RD&E’s team do not care so long as they can blame the problem on another team or the ‘system’ or another ‘authority’.